Better perceived health among the Swedish-speaking minority as compared with the Finnish-speaking majority in Finland: a cross-sectional study with an intergenerational perspective.

BACKGROUND: Previous research has shown that the Swedish speaking minority in Finland has slightly but significantly better health compared with the Finnish speaking majority. However, a clear explanation for this is lacking. AIM: The aim of the study was to explore differences of perceived health comparing three groups: Swedish speakers with reported dominance of Swedish also in the preceding generation; contemporary Finnish speakers with reported dominance of Finnish in the preceding generation and a group with a reported mixed-language structure of Finnish and Swedish between generations. INDIVIDUALS AND METHODS: Health and Social Support is an on-going population-based survey initiated in 1998 (N = 64,797), aimed at working-age adults. The present study is based on the 2012 follow-up survey, which included a question on the dominating language (Swedish or Finnish) of the respondents and their parents. The outcome was perceived health, which in this study was dichotomized to very good/good and intermediate/poor/very poor. The statistical analysis was carried with logistic regression, using SAS software. Age, gender and occupational training were included as covariates in the multivariable analysis. RESULTS: This study found that the Swedish-speaking group in Finland report better perceived health compared with the Finnish-speaking group (odds ratio 1.28, 95% confidence interval 1.04-1.57, p < 0.001). The health of the mixed language-speaking group fell between the other two groups. CONCLUSIONS: The results gave some support to a culturally mediated mechanism for the health advantage of Swedish speakers. Cultural features of Swedish-speaking groups in Finland may also support health promotion of the Finnish-speaking majority.

A healthy lifestyle can support future sexual satisfaction: results from a 9-year longitudinal survey.

BACKGROUND: Previous follow-up studies have demonstrated the association between good health behavior and good sexual functioning for men, but the longitudinal relationship between multiple health behaviors and satisfaction with sex life remains understudied. AIM: The aim of the study was to explore whether good health behavior associates with improved satisfaction with sex life for men and women in a follow-up of 9 years. METHODS: This cohort study utilized survey data from the population-based Health and Social Support study. It includes responses from 10 671 working-aged Finns. Using linear regression models, we examined a composite sum score representing 4 health behaviors (range, 0-4) in 2003 as a predictor of satisfaction with sex life in 2012. The analyses adjusted for various covariates in 2003, including satisfaction with sex life, living status, age, gender, education, number of diseases, and importance of sex life in 2012. OUTCOMES: The outcome in the study was satisfaction with sex life in the year 2012. RESULTS: Participants who exhibited better health behavior at baseline demonstrated improved satisfaction with sex life when compared with those with poorer health behavior (ß = -0.046, P = .009), even when controlling for the aforementioned covariates. The positive effect of reporting all beneficial health behaviors vs none of them was greater than having none vs 3 chronic conditions. Furthermore, this was almost half the effect of how satisfaction with sex life in 2003 predicted its level in 2012. These findings were supported by an analysis of the congruence of health behavior in the observation period from 2003 to 2012 predicting changes in satisfaction with sex life. CLINICAL IMPLICATIONS: The results could serve as a motivator for a healthy lifestyle. STRENGTHS AND LIMITATIONS: The current study used a longitudinal large sample and a consistent survey procedure, and it explored the personal experience of satisfaction instead of sexual function. However, the study is limited in representing today's diversity of gender, since the options for gender at the time of survey were only male and female. CONCLUSION: These findings indicate that engaging in healthy behaviors contributes to the maintenance and enhancement of satisfaction with sex life over time.

A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years.

BACKGROUND: Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. OBJECTIVES: The aim of the study was to determine whether having a named GP is associated with hospital service use. METHODS: The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). RESULTS: A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. CONCLUSION: A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.

Do Patients' Psychosocial Characteristics Impact Antibiotic Prescription Rates?

Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients' psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between a patient's psychosocial characteristics (self-reported in postal surveys in 2003) and the number of antibiotics they were prescribed (recorded in Finnish national registry data between 2004-2006) were analyzed for 19,300 working-aged Finns. Psychosocial characteristics included life satisfaction, a sense of coherence, perceived stress, hostility, and optimism. In a structural equation model, patients' adverse psychosocial characteristics were not related to increased antibiotic prescriptions in the subsequent three years. However, these characteristics were strongly associated with poor general health status, which in turn was associated with an increased number of subsequent antibiotic prescriptions. Furthermore, mediation analysis showed that individuals who used healthcare services more frequently also received more antibiotic prescriptions. The current study does not support the view that patients' adverse psychosocial characteristics are related to an increased number of antibiotic prescriptions. This could encourage physicians to actively discuss treatment options with their patients.

Defined daily dose definition in medication adherence assessment in asthma.

Adherence to inhaled corticosteroids (ICS) has been described as poor. In adherence studies, if the actual prescribed dosing is not available, generic defined daily doses (DDD) are applied instead when assessing adherence. We evaluated asthma patients' adherence in a large prospective follow-up survey. We also analysed whether World Health Organization (WHO) and Global Initiative for Asthma (GINA) reference doses give different results. The current study was cross-sectional and included respondents attending to HeSSup follow-up questionnaire in 2012. Altogether 1,141 of 12,854 adult participants answered positively to the question about having asthma. According to the Finnish Social Insurance Institutions' medication register, 686 of them had purchased ICS medication during 2011. DDDs for ICS by WHO as well as medium doses from GINA report were used as reference doses to evaluate adherence. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. If the lower limit of GINA medium ICS dose was used as a reference, 65% of the patients were adherent (PDC ≥ 80%). Use of WHO's DDD as reference halved the proportion of adherent patients. Adherence was higher among those using a combination inhaler of corticosteroid and long-acting ß2-agonist compared to those using steroid only inhalers. Use of WHO's daily defined doses as reference values may lead to underestimation of adherence to inhaled corticosteroids. Thus, attention should be paid when choosing the reference doses for the evaluation of adherence to inhaled corticosteroids in asthma.

Educational level and the use of mental health services, psychotropic medication and psychotherapy among adults with a history of physician diagnosed mental disorders.

BACKGROUND: The prevalence of mental disorders is increased among people of low socioeconomic status or educational level, but it remains unclear whether their access to treatment matches their increased need. AIMS: Our objective was to examine whether educational level as an indicator of socioeconomic status is associated with use of mental health services, psychotropic medication and psychotherapy in Finland. METHOD: Cross-sectional data from a follow-up survey of a longitudinal, population-based cohort study were used to form a sample of 3,053 men and women aged 24 to 68 with a current or previous physician diagnosed mental disorder. The prevalence of mental disorders, mental health service use and educational level were assessed with self-report questionnaire. Educational level was determined by the highest educational attainment and grouped into three levels: high, intermediate and low. The associations between educational level and mental health service -related outcomes were assessed with binary logistic regression. Covariates in the fully adjusted model were age, gender and number of somatic diseases. RESULTS: Compared to high educational level, low educational level was associated with higher odds of using antidepressants (OR 1.35, 95% CI [1.09, 1.66]), hypnotics (OR 1.33, 95% CI [1.07, 1.66]) and sedatives (OR 2.17, 95% CI [1.69, 2.78]), and lower odds of using mental health services (OR 0.80, 95% CI [0.65, 0.98]). No associations were found between educational level and use of psychotherapy. CONCLUSIONS: The results do not suggest a general socioeconomic status related mismatch. A pharmacological emphasis was observed in the treatment of low educational background participants, whereas overall mental health service use was emphasized among high educational background participants.

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study.

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.

A named GP increases self-reported access to health care services.

BACKGROUND: Continuity of care strengthens health promotion and decreases mortality, although the mechanisms of these effects are still unclear. In recent decades, continuity of care and accessibility of health care services have both decreased in Finland. OBJECTIVES: The aim of the study was to investigate whether a named and assigned GP representing continuity of care is associated with the use of primary and hospital health care services and to create knowledge on the state of continuity of care in a changing health care system in Finland. METHODS: The data are part of the Health and Social Support (HeSSup) mail survey based on a random Finnish working age population sample of 64,797 individuals drawn in 1998 and follow-up surveys in 2003 and 2012. The response rate in 1998 was 40% (n = 25,898). Continuity of care was derived from the 2003 and 2012 data sets, other variables from the 2012 survey (n = 11,924). The principal outcome variables were primary health care and hospital service use reported by participants. The association of the explanatory variables (gender, age, education, reported chronic diseases, health status, smoking, obesity, NYHA class of any functional limitation, depressive mood and continuity of care) with the outcome variables was analysed by binomial logistic regression analysis. RESULTS: A named and assigned GP was independently and significantly associated with more frequent use of primary and hospital care in the adjusted logistic regression analysis (ORs 1.53 (95% CI 1.35-1.72) and 1.19 (95% CI 1.08-1.32), p < 0.001). CONCLUSION: A named GPs is associated with an increased use of primary care and hospital services. A named GP assures access to health care services especially to the chronically ill population. The results depict the state of continuity of care in Finland. All benefits of continuity of care are not enabled although it still assures treatment of population in the most vulnerable position.

Feeling Unsafe at School Among Adolescents in 13 Asian and European Countries: Occurrence and Associated Factors.

Background: Research on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic. Methods: The present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals. Findings: The number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries. Conclusion: The findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion.

Changed health behavior improves subjective well-being and vice versa in a follow-up of 9 years.

BACKGROUND: Previous research on health behavior and subjective well-being has mainly focused on interindividual differences or explored certain domains of health behavior. Good health behavior and subjective well-being at baseline can predict each other after a follow-up. In the present cohort study, we explored the outcomes of change for an individual i.e., how changed health behavior is reflected in subsequent subjective well-being and vice versa. METHODS: Data (n = 10,855) originates from a population-based Health and Social Support (HeSSup) study on working-age Finns in 2003 and 2012. A composite measure of health behavior included physical activity, dietary habits, alcohol consumption, and smoking status (range 0-4, worst-best) and a composite measure of subjective well-being (with reversed scoring) included three life assessments, i.e., interest, happiness, and ease in life, and perceived loneliness (range 4-20, best-worst). Different multiple linear regression models were used to study how changes in health behavior predict subjective well-being and the opposite, how changes in subjective well-being predict health behavior. RESULTS: A positive change in health behavior from 2003 to 2012 predicted better subjective well-being (i.e., on average 0.31 points lower subjective well-being sum score), whereas a negative change predicted poorer subjective well-being (i.e., 0.37 points higher subjective well-being sum score) (both: p < 0.001) compared to those study subjects who had no change in health behavior. Similarly, when a positive and negative change in subjective well-being was studied, these figures were 0.071 points better and 0.072 points worse (both: p < 0.001) health behavior sum score, respectively. When the magnitude of the effect of change was compared to the range of scale of the outcome the effect of health behavior change appeared stronger than that of subjective well-being. CONCLUSION: Changes in health behavior and subjective well-being have long-term effects on the level of the other, the effect of the first being slightly stronger than vice versa. These mutual long-term benefits can be used as a motivator in health promotion on individual and societal levels.

Prevalent migraine as a predictor of incident hypertension.

BACKGROUND: Migraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013. METHODS: The present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets. RESULTS: A significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20-1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables. CONCLUSION: Extra attention should be paid to prevention and control of hypertension in working-age migraine patients.

The long-term cost of childhood conduct problems: Finnish Nationwide 1981 Birth Cohort Study.

BACKGROUND: Commonly recognized childhood conduct problems often lead to costly problems in adulthood. This study aimed to evaluate the long-term cumulative cost of childhood conduct problems until the age of 30. The costs included inpatient care, nervous system medicine purchases, and criminal offences. METHODS: The study used population-based nationwide 1981 birth cohort data. Families and teachers assessed the conduct problems of the eight-year-olds based on Rutter questionnaires. We grouped 5,011 children into low-level of conduct problems (52%), intermediate-level of conduct problems (37%), and high-level of conduct problems (11%) groups, based on combined conduct symptoms scores. The analysis included the cohort data with the Care Register for Health Care, the Drug Prescription Register, and the Finnish Police Register. The cost valuation of service use applied national unit costs in 2016 prices. We used Wilcoxon rank-sum test to test the differences between groups and gender. RESULTS: During 1989-2011, average cumulative costs of the high-level (€44,348, p < .001) and the intermediate-level (€19,405, p < .001) of conduct problems groups were higher than the low-level of conduct problems group's (€10,547) costs. In all three groups, the boys' costs were higher than girls' costs. CONCLUSIONS: The costs associated with conduct problems in childhood are substantial, showing a clear need for cost-effective interventions. Implementation decisions of interventions benefit from long-term cost-effectiveness modelling studies. Costing studies, like this, provide cost and cost offset information for modelling studies.

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study.

Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels.

Climacteric symptoms more severe in 2010 than in 2000 - experience of Finnish women aged 52-56 years not now or previously on menopausal hormone therapy.

OBJECTIVES: To analyze and compare the experience of climacteric symptoms and their associations with sociodemographic and health-related characteristics in two cohorts of Finnish women aged 52-56 years, born ten years apart and not now or previously on menopausal hormone therapy (MHT). STUDY DESIGN: Nationwide population-based time-trend study with a large number of participants (n = 1986 + 1988). MAIN OUTCOME MEASURES: The experience of climacteric symptoms was assessed by 12 commonly used menopause-related symptoms. RESULTS: Women aged 52-56 experienced more moderate or severe symptoms and fewer mild symptoms in 2010 than in 2000. Being unemployed or inactive was associated with more severe symptoms (P = 0.007), but employment status had no effect on the relative odds estimates. CONCLUSIONS: The influence of the birth cohort and time-period effects as well as work-related factors on the experience of climacteric symptoms in women not now or previously on MHT needs further research, particularly since the change in the experience of symptoms found in this study occurred within only ten years.

Longitudinal stability and interrelations between health behavior and subjective well-being in a follow-up of nine years.

BACKGROUND: The bidirectional relationship between health behavior and subjective well-being has previously been studied sparsely, and mainly for individual health behaviors and regression models. In the present study, we deepen this knowledge focusing on the four principal health behaviors and using structural equation modeling with selected covariates. METHODS: The follow-up data (n = 11,804) was derived from a population-based random sample of working-age Finns from two waves (2003 and 2012) of the Health and Social Support (HeSSup) postal survey. Structural equation modeling was used to study the cross-sectional, cross-lagged, and longitudinal relationships between the four principal health behaviors and subjective well-being at baseline and after the nine-year follow-up adjusted for age, gender, education, and self-reported diseases. The included health behaviors were physical activity, dietary habits, alcohol consumption, and smoking status. Subjective well-being was measured through four items comprising happiness, interest, and ease in life, and perceived loneliness. RESULTS: Bidirectionally, only health behavior in 2003 predicted subjective well-being in 2012, whereas subjective well-being in 2003 did not predict health behavior in 2012. In addition, the cross-sectional interactions in 2003 and in 2012 between health behavior and subjective well-being were statistically significant. The baseline levels predicted their respective follow-up levels, the effect being stronger in health behavior than in subjective well-being. CONCLUSION: The four principal health behaviors together predict subsequent subjective well-being after an extensive follow-up. Although not particularly strong, the results could still be used for motivation for health behavior change, because of the beneficial effects of health behavior on subjective well-being.

Health behavior of working-aged Finns predicts self-reported life satisfaction in a population-based 9-years follow-up.

BACKGROUND: Previous studies have shown positive association between health behavior and life satisfaction, but the studies have mostly been cross-sectional, had follow-up times up to 5 years or focused on only one health behavior domain. The aim of the study was to explore how principal health behavior domains predict life satisfaction as a composite score in a previously unexplored longitudinal setting. METHODS: The present study tested whether a health behavior sum score (range 0-4) comprising of dietary habits, smoking, alcohol consumption, and physical activity predicted subsequent composite score of life satisfaction (range 4-20). Data included responses from 11,000 working-age Finns who participated in the Health and Social Support (HeSSup) prospective population-based postal survey. RESULTS: Protective health behavior in 2003 predicted (p < .001) better life satisfaction 9 years later when sex, age, education, major diseases, and baseline life satisfaction were controlled for. The ß in the linear regression model was - 0.24 (p < .001) corresponding to a difference of 0.96 points in life satisfaction between individuals having the best and worst health behavior. CONCLUSION: Good health behavior has a long-term beneficial impact on subsequent life satisfaction. This knowledge could strengthen the motivation for improvement of health behavior particularly on an individual level but also on a policy level.

Stroke and cardiovascular risk factors among working-aged Finnish migraineurs.

BACKGROUND: The aim of our study was to evaluate the risk for comorbid cardio- and cerebrovascular diseases in the working-aged migraine population of Finland. METHODS: A total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included. The study material was linked with two registers. ICD diagnoses I63 for ischemic stroke (IS), I21 - I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study participants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012. Reimbursed triptan prescriptions were drawn from the national Social Security Institution (SII) data. The self-reported vascular risk factors were hypertension, high cholesterol values, any diabetes, myocardial infarction, stroke, and TIA. Odds Ratios (OR) with 95% confidence (95% CI) intervals were assessed for diagnosed stroke, myocardial infarction, and TIA. RESULTS: Migraineurs were mostly female (82%) and ≥ 54 years old (62%). Triptans were reimbursed among 34.7% of migraineurs. A self-reported hypertension (21%), high serum cholesterol (38%), and any diabetes (7%) were more common among migraineurs vs controls (p < 0.05). There was no risk for AMI. The risk for TIA (OR 3.20, 95% CI 1.45-7.05) and IS (2.57, 95% CI 1.28-5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking. The risk was higher among women in two groups ≥54 years (3.25, 95% CI 1.35-7.84 and 5.0, 95% CI 1.94-12.89, respectively). The average age for IS in migraine was 57.5 years and for TIA 58.2 years among women, and 52.8 years and 50.3 years among men, respectively. CONCLUSION: Cardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women. Efficacious attack treatment with triptans should be offered to migraine patients who do not show contraindications.

Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators.

OBJECTIVE: This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood. METHODS: Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators). RESULTS: Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE-asthma association were 'severe financial difficulties' (24%), 'emotional, physical or sexual violence' (15%), 'major increase in marital problems' (8%), 'severe conflicts with supervisor' (7%), and 'divorce or separation' (5%). CONCLUSIONS: Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset.

Subjective well-being predicts health behavior in a population-based 9-years follow-up of working-aged Finns.

The cross-sectional association between measures of subjective well-being (SWB) and various health behaviors is well-established. In this 9-year (2003-2012) follow-up study, we explored how a composite indicator of SWB (range 4-20) with four items (interest, happiness, and ease in life, as well as perceived loneliness) predicts a composite health behavior measure (range 0-4) including dietary habits, physical activity, alcohol consumption, and smoking status. Study subjects (n = 10,855) originated from a population-based random sample of working-age Finns in the Health and Social Support study (HeSSup). According to linear regression analysis, better SWB predicted better health behavior sum score with a ß = 0.019 (p < 0.001) with a maximum effect of 0.3 points after adjusting for age (p = 0.038), gender (p < 0.001), education (p = 0.55), baseline self-reported diseases (p = 0.020), baseline health behavior (ß = 0.49, p < 0.001), and the interaction between SWB and education (p < 0.001). The results suggest that SWB has long-term positive effect on health behavior. Thus, interventions aiming at health behavioral changes could benefit from taking into account SWB and its improvement in the intervention.